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  • Ana Paula Etges

Patient-level cost set for Heart Failure: an initiative from the TDABC Consortium

A project proposed by the TDABC Consortium Members

Aiming to contribute to the generation of accurate cost information, the Time-Driven Activity-Based Costing (TDABC) Consortium started an international initiative to create the first ‘Patient-level cost set’ during its First TDABC in Healthcare conference. The clinical condition of heart failure (HF), which is responsible for a high cost burden in many health care systems, was selected as a pilot project and the scientific committee is currently working on starting the project in multiple centers worldwide.

The process to develop a ‘Patient-level cost set’ considers the steps of the TDABC method and the methodology adopted by the International Consortium for Health Outcomes Measurement (ICHOM) to develop an outcomes “standard-set”. As a first activity, the multiple care pathways in which HF patients could be placed were mapped. A clinical committee with a background in cardiovascular medicine was invited to collaborate on this step and guided the stratification of the HF care pathways in a group of conditions profiles: outpatient follow-up treatment, day hospital visit treatment; emergency room treatment; and hospitalization. In the hospitalization profile, a few interventions were identified and fragmented into different pathways: the use of cardiac devices (excluding VADs); surgical intervention, heart transplantation; and the use of ventricular assist devices (VADs). The sequence of therapeutic activities to which patients are usually subjected was identified for each pathway. This general process map of HF will be used as a reference for designing the data collection instruments to be followed by hospitals from several countries during the pilot project. Hospitals from Europe and Latin America have already demonstrated interest in running this pilot project.

Among the expected results of this initiative are the capability to provide instruments to measure accurate cost information, guide the execution of cost variability analysis, and, consequently, identification of benchmarks of care delivery in the heart failure population by considering outcomes and cost results. By doing that, the ‘patient-level cost set’ might represent a paradigm shift in how cost information being presented by allowing the use of more accurate and relevant financial information to redesign health care policies centered around population health.

This project aims to develop, apply, and internationally validate the first patient-level cost set for heart failure.

Secondary objectives:

  • Develop a minimum viable product (MVP) of a digital platform to scale the use of the patient-level set for HF.

  • Identify the benchmarks of care in terms of resource consumption and outcomes generated between the center participants of the pilot project.

  • Provide accurate cost and resource consumption information of HF in several countries.

  • Analyze how accurate cost information can be better used to sustain reimbursement strategies for HF.

  • Identify opportunities to reduce the burden of HF.

  • To consolidate the methodology to develop patient-level sets.

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